Temporal Changes in Racial Disparities of HIV Linkage to Care from 2013 to 2020: A Statewide Cohort Analysis.

IF 2.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Journal of Racial and Ethnic Health Disparities Pub Date : 2026-04-01 Epub Date: 2025-02-28 DOI:10.1007/s40615-025-02355-3

Fanghui Shi, Katherine E Weaver, Chen Zhang, Bankole Olatosi, Jiajia Zhang, Sharon Weissman, Xiaoming Li, Xueying Yang

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Abstract

Background: Racial disparities have historically existed regarding HIV care outcomes, including linkage to care. This study aims to explore the contribution of contextual features (e.g., socioeconomic and structural environmental factors) to the temporal change of county-level racial disparities in linkage to care.

Methods: This is a statewide population-based retrospective cohort study. The patient-level variables in the South Carolina HIV registry system were used to calculate the aggregated county-level linkage to care percentage. Then, we used four indices to measure racial disparities in the county-level percentage of timely linkage to care, i.e., the Black-White ratio, index of disparity (ID), weighted ID, and Gini coefficient. Linear mixed-effect models were used to estimate the relationship between a variety of contextual features and disparity indexes. The analysis included data from 2013 to 2020, with 2013 as the start year due to the availability of key contextual features and 2020 as the end year based on the most recent HIV registry data available at the time of this study.

Results: Across 46 counties in South Carolina, racial disparity in linkage to care persisted between 2013 and 2020, as indicated by all four indices. When using ID, weighted ID, and Gini as outcomes, counties with lower degrees of racial residential segregation and stronger family structure were at higher risk of racial disparities in linkage to care. For weighted ID only, counties with fewer primary care providers (β = - 4.22; 95% CI, - 7.23 ~ 1.23) had larger racial disparities in linkage to care. Furthermore, for Gini only, counties with higher income inequalities (β = 0.01; 95% CI, 0.00 ~ 0.02) had larger racial disparities in linkage to care.

Conclusion: Efforts to address racial disparities should continue, and innovative approaches, specifically those that focus on social and structural factors, should be developed and implemented for populations that have poor HIV outcomes in the USA.

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从 2013 年到 2020 年，HIV 相关护理的种族差异的时间变化：全州队列分析。

背景：种族差异历来存在于艾滋病毒护理结果，包括与护理的联系。本研究旨在探讨背景特征（如社会经济和结构环境因素）对县域种族照护联系差异时间变化的贡献。方法：这是一项基于全州人群的回顾性队列研究。在南卡罗来纳HIV登记系统中的患者水平变量被用来计算总的县级联系护理百分比。然后，我们使用4个指标，即黑人-白人比率、差距指数（ID）、加权ID和基尼系数，来衡量县级及时联系医疗百分比的种族差异。使用线性混合效应模型来估计各种上下文特征与差异指数之间的关系。该分析包括2013年至2020年的数据，由于关键背景特征的可用性，2013年为开始年，根据本研究时可用的最新艾滋病毒登记数据，2020年为结束年。结果：正如所有四个指数所表明的那样，在南卡罗来纳州的46个县，2013年至2020年期间，与护理联系的种族差异持续存在。当使用ID、加权ID和基尼系数作为结果时，种族居住隔离程度较低、家庭结构较强的县在与护理联系方面存在更高的种族差异风险。仅对于加权ID，初级保健提供者较少的县(β = - 4.22；95% CI, - 7.23 ~ 1.23)在与护理相关方面存在较大的种族差异。此外，仅就基尼系数而言，收入不平等程度较高的县(β = 0.01；95% CI, 0.00 ~ 0.02)在与护理相关方面存在较大的种族差异。结论：解决种族差异的努力应该继续，创新的方法，特别是那些关注社会和结构因素的方法，应该针对美国艾滋病毒治疗效果不佳的人群开发和实施。

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来源期刊

Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

5.10%

发文量

263

期刊介绍： Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.